支架内再狭窄病变分型对单纯紫杉醇药物涂层球囊治疗患者预后的影响

目的研究在单纯紫杉醇药物涂层球囊(PCB)治疗条件下,支架内再狭窄(ISR)分型与患者临床预后的关系。方法从2015年12月~2017年6月在我院行冠状动脉造影证实为ISR并行单纯PCB治疗的283例患者中筛选出仅具有单个靶病变的患者246例。将这246例患者分为局灶型病变组(n=101)及非局灶型病变组(n=145)。主要终点事件为术后12个月靶病变血运重建(TLR),次要终点事件为12个月主要心血管不良事件(MACE),包括TLR、心源性死亡、心肌梗死(MI),及靶血管血运重建、全因性死亡、支架内血栓形成。结果两组患者临床基线资料无显著差异。非局灶组普通预扩球囊的使用率高于局灶组(P<0.01),长度较长(P=0.01)。局灶组切割球囊的直径大于非局灶组(P<0.01)。同时局灶组药物涂层球囊直径大于非局灶组(P<0.01),而长度小于非局灶组(P<0.01)。随访12个月显示非局灶组的血运重建、TLR、MACE等事件的发生率均显著高于局灶组(均P<0.05)。对这246例患者做无事件生存率分析显示局灶组无TLR事件生存率及无MACE事件生存率均显著优于非局灶组(均P<0.05)。结论 ISR分型是单纯PCB治疗后患者临床事件发生的重要预测因素;PCB应用于支架内再狭窄病变是安全有效的。

Impact of restenosis pattern on clinical outcomes after simple paclitaxel-coated balloon angioplasty for in-stent restenosis

AIM To discuss the relationship between the pattern of in-stent restenosis (ISR) and clinical prognosis in patients treated with a Paclitaxel-coated Balloon (PCB). METHODS 246 patients with one target lesions were screened from 283 patients who underwent coronary angiography. These patients were diagnosed with ISR and treated with PCB. The 246 patients were divided into a focal lesion group (n = 101) and a non-focal lesion group (n = 145). The primary end point was target lesion revasculation (TLR) at 12 months. Secondary end points were 12-month major adverse cadiac events (MACE) (e.g., cardiac death, myocardial infarction, and TLR), and target vessel revascularization, all-cause death, and stent thrombosis. RESULTS There was no significant difference in clinical baseline data between the two groups. The rate of compliance balloon in the non-focal group was higher than that in the focal group (P < 0.01) and the length was longer (P = 0.01). the diameter of the cutting was larger in the focal group than that in the non-focal group (P < 0.05). The diameter of PCB in the focal group was larger (P < 0.01), and the length was shorter (P < 0.01). The event-free survival analysis of these 246 patients showed that the survival rate of TLR-free events in the focal group (P < 0.05) and the survival rate without MACE events (P < 0.05) were superior to those in the non-focal group. CONCLUSION AfterAfter PCB angioplasty for ISR, the morphologic pattern of ISR is also an important predictor of outcomes. The use of PCB for in-stent restenosis is safe and effective.